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Urgent action needed to improve the mental health and save the lives of Australian doctors and medical students

07 Oct 2013

A world-first survey of thousands of Australian doctors and medical students has revealed they are burnt-out, more likely to experience psychological distress and suicidal thoughts than the general community and are drinking too much alcohol.

beyondblue’s National Mental Health Survey of Doctors and Medical Students found that medical students and young or female doctors are most at risk and identified that significant levels of stigma towards people with mental health problems. Some respondents also reported that they were bullied or experienced racism.

beyondblue Chairman The Hon. Jeff Kennett AC said the findings revealed the extent of doctors’ and medical students’ suffering and should act as an immediate rallying call for action.

“We conducted this survey because, given doctors and medical students are under immense pressure and deal regularly with pain and death, we know that the mental health of many of them is poor,” he said. “This survey builds on our previous work in this area and we hope it also serves as a wake-up call to the Australian medical community that more must be done to tackle things such as over-work and discriminatory attitudes.”

beyondblue CEO Kate Carnell AO said more must be done not only to help doctors and students, but also patients.

“If doctors do not deal with the mental health issues they are experiencing, it can affect their ability to deliver the best care,” she said.

“This survey identifies the challenges the medical community faces and outlines how they can be tackled. This includes initiatives such as the development of a mental health strategy for the Australian medical community to promote good mental health, the development of guidelines around working hours, better mental health education in universities to reduce stigma, and awareness campaigns. The survey also shows some doctors experience bullying and racism, which is completely unacceptable. I encourage all medical workplaces to investigate how to create a mentally healthy workplace, starting with a visit to www.beyondblue.org.au/workplace.”

The survey, which was conducted by Roy Morgan and completed by more than 14,000 doctors and medical students, is believed to be the first anywhere in the world to provide a mental health snapshot of such a large proportion of a country’s medical community.

Some major findings include:

One in five medical students and one in 10 doctors had suicidal thoughts in the past year. More than four in 10 students and a quarter of doctors are highly likely to have a minor psychiatric disorder, like mild depression or mild anxiety

3.4% of doctors are experiencing very high psychological distress, much greater than the wider community

Oncologists are clearly the most psychologically distressed specialists while doctors who do not deal with patients (researchers, administrators, etc) think about suicide most often

Male doctors work longer hours (46 per week) and engage in more risky drinking but female doctors are more psychologically distressed and think about suicide more often

Young doctors work longer hours (50 per week on average), are far more psychologically distressed, think about suicide more and are more burnt-out than their older colleagues

Perceived stigma is rife with almost half of respondents thinking doctors are less likely to appoint doctors with a history of depression or anxiety and four in 10 agreeing that many doctors think less of doctors who have experienced depression or anxiety. 4.5% list bullying and 1.7% list racism as a cause of stress for them.

Available for interview: Mr Kennett, Ms Carnell, former Australian Medical Association president and Chair of beyondblue’s advisory committee Dr Mukesh Haikerwal AO and doctors who have experienced depression.

A selection of major findings from the report

Please note: Refer to the full report for details. All mean scores refer to the survey's findings unless otherwise stated.

In tables that list doctors by specialty, data provided by doctors who did not list their specialty have not been included.

Percentage of doctors by specialty who are highly likely to have a minor psychiatric disorder

Doctor by specialty

%

Oncology

33.9

Paediatrics

31.8

Non-patient

30.9

Anaesthetics

29.5

Imaging and pathology

28.4

Emergency medicine

27.5

Other

26.7

Rural/remote medicine or Aboriginal health

26.0

General practitioner

24.9

Obstetrics and gynaecology

24.7

Mental health

24.3

Surgery

20.5

Mean

27.2

Percentage of doctors by specialty who are experiencing very high psychological distress

Doctor by specialty

%

Oncology

5.5

Anaesthetics

3.8

Imaging and pathology

3.6

Obstetrics and gynaecology

3.4

Non-patient

3.3

Paediatrics

3.3

Other

3.1

Emergency medicine

2.9

General practitioner

2.9

Surgery

2.5

Mental health

2.3

Rural/remote medicine or Aboriginal health

1.7

Mean

3.4

Working hours by specialty, mean hours worked per week

Doctor by specialty

hours

Rural/remote medicine or Aboriginal health

50.9

Surgery

50.8

Obstetrics and gynaecology

48.3

Oncology

47.6

Other

45.4

Paediatrics

45.3

Anaesthetics

43.8

Emergency medicine

42.9

Imaging and pathology

42.9

Mental health

41.3

Non-patient

41.0

General practitioner

39.9

Mean

43.6

Percentage of doctors by specialty who drink at moderate risk levels

Doctors by specialty

%

Emergency medicine

17.2

Surgery

15.5

Anaesthetics

15.4

Rural/remote medicine or Aboriginal health

12.5

Other

11.8

General practitioner

11.7

Obstetrics and gynaecology

11.7

Paediatrics

11.7

Non-patient

11.0

Mental health

10.9

Imaging and pathology

10.3

Oncology

9.1

Mean

12.8

Percentage of doctors by specialty who drink at high risk or harmful levels

Doctors by specialty

%

Rural/remote medicine or Aboriginal health

3.6

Anaesthetics

3.4

Emergency medicine

2.9

Oncology

2.6

Mental health

2.5

Other

2.5

Surgery

2.3

General practitioner

2.3

Non-patient

1.9

Imaging and pathology

1.6

Paediatrics

1.0

Obstetrics and gynaecology

0.8

Mean

2.5

Percentage of doctors by specialty who listed bullying as a source of stress

Doctors by specialty

%

Non-patient

12.4

Imaging and pathology

6.0

Oncology

6.0

Surgery

5.5

Obstetrics and gynaecology

5.3

Paediatrics

5.3

Other

5.0

Mental health

4.8

Rural/remote medicine or Aboriginal health

4.1

Emergency medicine

3.8

Anaesthetics

3.7

General practitioner

3.2

Mean

4.5

Stigma

58.6% of doctors agreed that being a patient causes embarrassment for a doctor

47.9% agreed that doctors are less likely to appoint doctors with a history of depression or an anxiety disorder

44.8% agreed that many doctors believe that experiencing depression or an anxiety disorder is a sign of personal weakness

40.2% agreed that many doctors think less of doctors who have experienced depression or an anxiety disorder.

Reasons doctors don't get help for anxiety or depression

Fear of lack of confidentiality/privacy is the biggest barrier, with 52.5% doctors saying it is a barrier

37.4% said embarrassment is a barrier

34.3% said impact on registration and right to practice is a barrier.

Medical students

43% of medical students have a high likelihood of experiencing a minor psychiatric disorder and 9.2% have very high levels of psychological distress. The general community mean score for high psychological distress is 2.6%

19.2%, including 31.8% of Indigenous medical students, have had suicidal thoughts in the past year

21.3% are moderate risk drinkers while a further 4% are high risk drinkers

52.3% are experiencing emotional exhaustion.

Young doctors

Doctors aged 30 and under work the longest hours of any age group (49.8 hours a week compared to 43.6 mean)

These doctors are the most likely of any age group to be probably experiencing a minor psychiatric disorder (36.7% compared to 27.2% mean) and are the most likely to be experiencing very high psychological distress (5.9% compared to mean of 3.4%). The general community mean score for high psychological distress is 2.6%

These doctors are the most likely of any age group to have a current diagnosis of depression (10.4% compared to 6.2% mean) and are the most likely to have a current diagnosis of anxiety (4.9% compared to 3.7% mean)

These doctors are the most likely of any age group to have had suicidal thoughts in the past year (12.7% compared to 10.4% mean) and score the highest on the three burnout factors of high emotional exhaustion, high cynicism and low professional efficacy

Doctors who are at the intern or training stage rate similarly high on these measures.

Indigenous statistics

Approximately 0.2% of doctors who responded to the survey were Indigenous (this is a similar proportion to that reported in the 2011 census). As the sample size is small, results should be interpreted with caution.

However 22% were considered to have a high likelihood of having a minor psychiatric disorder. 22% of doctors also reported being very stressed by bullying, which is higher than levels reported by the general survey population (4.4%).

Approximately 1.2% of the student sample was Indigenous. 73% of Aboriginal and Torres Strait Islander students were classified as having a high likelihood of a minor psychiatric disorder. While interpretation is limited by the sample size, this is a substantially higher proportion in comparison to non-Indigenous students (43%). 27% reported very high psychological distress, which is again higher than that reported by non-Indigenous students (9%).

Doctors specialising in rural/remote/Aboriginal health work the longest hours (50.9 a week compared to 43.6 mean).

These doctors are the specialists most likely to be high risk or harmful drinkers (3.6% compared to 2.5% mean), the most likely to be experiencing high emotional exhaustion (38.9% compared to 31.6% mean) and have the second highest cynicism levels (38.4% have high levels compared to 34.6% mean).

Non-metropolitan doctors

Doctors in remote locations work the longest hours of any group by work area (46.2 hour a week compared to 43.6 mean)

They are the most likely by work area to be experiencing a minor psychiatric disorder (31.0%) and are the most likely to be experiencing very high psychological distress (4.8% compared to the community mean score of 2.6%)

They are the most likely by work area to have had suicidal thoughts in the past year (14.2% compared to 10.4% mean) and most likely to have ever attempted suicide (3.6% compared to 2.3% mean)

They are the most likely by work area to be moderate risk drinkers (15.5% compared to 12.8% mean) and harmful or high-risk drinkers (6.2% compared to 2.5% mean).